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Montana rates for HCPCS 64400

Injection Aa&/Strd Trigeminal Nerve Each Branch

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.97 / $191.97 / $426.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.59 / $99.76 / $184.56
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$407.03 / $830.88 / $830.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.27 / $81.50 / $179.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.50 / $81.50 / $81.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.75 / $118.73 / $211.27
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.50 / $87.09 / $150.91
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.29 / $121.34 / $219.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.78 / $135.78 / $135.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.38 / $179.94 / $239.58